FRIDAY September 12, 2014

Dr. John Zelem of EHR returned to advise us on what he’s been learning about this critical subject…

Our Guest was John Zelem, MD, FACS, General Surgeon and Senior Medical Director for Executive Health Resources (EHR), who returned to give us an update on what he’s been learning about this difficult task, since the first time he appeared on our show, back in February.

A Board Certified general surgeon with more than 26 years of clinical experience, Dr. Zelem is responsible for quality assessment and improvement at EHR’s client hospitals. For about the past year, he has been working closely with hospitals to provide ongoing education on a variety of topics including Medicare and Medicaid compliance and regulations, medical necessity, Recovery Audit Contractors, utilization review, denials management and length of stay. He also gets to see many records, denials and appeals; and he has much to say about some patterns he has seen, and what he’s been doing to help hospitals improve physician documentation.

We discussed these points on the show:

The electronic medical record has not been the savior for improving physician documentation

What are potential results of improved documentation

Examples of actual documentation deficiencies

Advice from 1400 BC: “So shall it be written… So shall it be done…”

Points to make to physicians – who’s watching and why

Somehow… we’re sure this is not the last time Dr. Zelem will be on to discuss this situation…

Replays and Handouts

Included in the Handouts this week:

Dr. Zelem’s Presentation in PDF [SLIDES]
Transmittal 540 as originally published on Sep 4 2014

Articles from Academy Blog

“Scope Creep” in Appeals is Dead CMS has instructed MACs and QICs to limit their review to the reason(s) the claim or line item at issue was initially denied. For redeterminations and reconsiderations of claims denied following a complex prepayment review, a complex post-payment review, or an automated post-payment review by a contractor, Limiting the scope of review on redeterminations and reconsiderations of certain claims. MLN Matters Number SE1521.